Prognostic importance of the axillary lymph node ratio in autologous transplantation for high-risk stage II/III breast cancer

Abstract

Summary:The role of autologous peripheral blood progenitor cell (PBPC) transplantation for high-risk stage II/III breast cancer remains controversial. New prognostic indicators defining subsets of patients who may benefit from autologous PBPC transplantation would be clinically useful. The axillary lymph node ratio, defined by the total number of axillary nodes involved with cancer divided by the number of axillary nodes surgically sampled, has been reported to be of potential prognostic importance in transplantation for high-risk, stage II/III breast cancer. We therefore retrospectively reviewed 111 women with high-risk, stage II/III breast cancer with at least four positive axillary lymph nodes undergoing autologous PBPC transplantation from 1991 to June 1999. None of the patients had received prior radiotherapy and all had completed one, and only one, course of at least three cycles of adjuvant chemotherapy. The median number of axillary nodes sampled was 20 (range 6-40) and the median number of positive axillary nodes was 12 (range 4-35). The median node ratio, dividing the number of positive nodes by the number of sampled nodes, was 0.68. Event-free survival was strongly influenced by node ratio. Patients having a node ratio of Ͻ0.7 had a 5-year event-free survival of 68%, vs those with a node ratio of у0.7 with a 5-year event-free survival of 46% (P = 0.03). Forty percent of patients with a high node ratio have relapsed vs 20% with a low node ratio (P = 0.02). Multivariate analysis revealed that positive estrogen receptor status and a node ratio of Ͻ0.7 were independent factors related to better event-free survival (P = 0.0001 and P = 0.004, respectively). We conclude that patients having a node ratio of Ͻ0.7 have a significantly better prognosis following autologous PBPC transplantation than do patients with a ratio у0.7. Bone Marrow Transplantation (2001) 27, 843-846.

Long-Term Analysis and Prospective Validation of a Prognostic Model for Patients with High-Risk Primary Breast Cancer Receiving High-Dose Chemotherapy

“…This was in contrast to the lack of a significant predictive value of the number of involved nodes alone in our analysis. These observations were subsequently confirmed by others in their analyses of HRPBC populations treated with HDC (25)(26)(27). Recent reports of patients receiving adjuvant SDC also indicate the emerging importance of the nodal ratio, the number of uninvolved nodes, or the total number of dissected nodes (28 -35).…”

Adjuvant treatment of high-risk stage II breast cancer with doxorubicin followed by high-dose chemotherapy and autologous stem-cell transplantation: a single-institution experience with 132 consecutive patients

“…This is in line with other studies showing a marked reduction in transplant-related mortality when using peripheral stem-cell support. 12 With regard to the specific role of the adjuvant regimen in these trials Rodenhuis et al, 3 Hortobagyi, 13,14 Gianni and transplanted groups. There was no statistical difference in overall survival in the two groups of patients (P ¼ 0.198).…”

Prognostic Significance of the Number of Removed and Metastatic Lymph Nodes and Lymph Node Ratio in Breast Carcinoma Patients with 1–3 Axillary Lymph Node(s) Metastasis

“…LNR threshold value separating the whole series in two prognostic groups with significantly different survival was given as 0.20 [18, 24] and 0.25 [9]. In three series including patients with N2 and N3 disease receiving adjuvant high-dose chemotherapy with stem-cell support, LNR threshold value of prognostic significance was determined as 0.80 by Nieto et al [25] and Schneeweiss et al [26], and 0.70 by Bolwell et al [27]. Our group determined the LNR threshold value as 0.80 in a previous study including patients with T1,2,3N3M0 disease [28].…”